Association Of Age At Menopause With Metabolic Syndrome And Its Components In Middle-aged And Elderly Women In Guangzhou

Background:Menopause is an important period in a woman’s life,when the ovaries are about to fail,which means that the female reproductive marker is about to end.Menopausal women are prone to metabolic disorders,which may be related to changes in estrogen levels.Every woman goes through menopause,but at different ages.Some studies have reported that the age at menopause is associated with the occurrence of some diseases.Studies on the relationship between age at menopause and Metabolic syndrome(MS)are relatively scarce at home and abroad,and the evidence is limited.In the study of the components of metabolic syndrome,the research results at home and abroad showed that the age at menopause was positively correlated with obesity and hypertension,some results showed negative correlation,and some results found that there was a nearly "U" trend.Moreover,obesity is the cause of many diseases.Obesity may be an intermediate link in the relationship between age at natural menopause and elevated blood pressure.Effective evaluation of this relationship can provide new ideas for exploring the mechanism of postmenopausal hypertension and provide targets for the prevention and control of postmenopausal hypertension.Objective:To explore the relationship between menopausal age and metabolic syndrome,obesity and hypertension,and to analyze the mediating effect of obesity on the relationship between menopausal age and blood pressure,so as to provide scientific reference for the prevention and control of metabolic syndrome,obesity and hypertension in middle-aged and elderly women,and to put forward relevant suggestions for obesity management.Methods:Based on the baseline data of Guangzhou Prospective Cohort Study of Chronic Diseases in Middle-aged and Elderly people,a total of 5429 middle-aged and elderly natural menopausal women in Guangzhou were selected as study subjects.Information on gender,age,socioeconomic status(education level,occupation,annual household income),lifestyle(physical activity,dietary habits,smoking,drinking),history of disease,age at menopause,age at menarche,parity,menopause pattern and other reproductive factors were collected through questionnaire survey.Waist circumference,hip circumference,height,weight,blood pressure,fasting blood glucose,blood lipid and other indicators were measured.Restricted cubic spline(RCS)was used to plot the dose-response curves of age at menopause with metabolic syndrome,obesity and hypertension.Generalized linear model was used to analyze the differences of MS components in different menopausal age groups.Binary logistic regression model was used to analyze the relationship between age at menopause and MS,obesity and hypertension,and the relationship between age at menopause and MS in different menopausal years.Multi-class logistic regression model was used to analyze the correlation between age at menopause and MS group scores.The Odds ratio(OR)and95% confidence interval(95%CI)were calculated.The mediating effect model was used to analyze the mediating effect of obesity indicators on the relationship between age at menopause and blood pressure,and the percentage of mediating effect of each obesity indicator in the total effect was calculated.The indicators of obesity included Body Mass Index(BMI),Waist circumference(WC),Waist-to-hip Ratio(WHR)and Waist-to-height Ratio(WHt R).The adjusted confounders included age,education level,occupation,annual household income,smoking,alcohol consumption,dietary habits,physical activity,age at menarche,and parity.Results:The mean age of participants was(60.0±5.8)years,and the mean menopausal age was(50.3±3.1)years.The prevalence of metabolic syndrome was 14.0%(758/5429).After adjusting for confounding factors,age at menopause showed a U-shaped association with MS,obesity and hypertension.Compared with normal menopausal age group,early(OR=1.42,95%CI:1.07-1.87)and late age at menopause(OR=1.56,95%CI: 1.26-1.94)increased the risk of MS.Late age at menopause increased the risk of having 1(OR=1.28,95%CI: 1.03-1.60),2(OR=1.49,95%CI: 1.18-1.90)and 3 or more(OR=1.96,95%CI: 1.51-2.52)metabolic syndrome scores.When time since menopause were less than 10 years,late age at menopause(OR=1.75,95%CI:1.31-2.35)increased the risk of MS.Early and late age at menopause increased the risk of central obesity judged by WC,OR(95%CI)were 1.30(1.01-1.67)and 1.38(1.13-1.68),respectively.WHR also increased the risk of central obesity(1.30(1.04-1.62)and 1.41(1.19-1.68)).And increased the risk of central obesity judged by WHt R(1.27(1.02-1.58)and 1.41(1.19-1.68));And increased the risk of overweight and obesity based on BMI(1.42(1.15-1.75)and 1.49(1.26-1.76)).Late age at menopause(OR=1.46,95%CI: 1.22-1.75)increased the risk of hypertension.Combined with the RCS plot,the disease OR value was the smallest at the menopausal age of 50 years.The menopausal age was divided into two groups: menopausal age <50 years and menopausal age ≥50 years.When menopausal age <50 years old,obesity had no mediating effect on the relationship between age at menopause and blood pressure.When menopausal age was ≥50 years old,obesity had a mediating effect on the relationship between age at menopause and blood pressure.Among them,the mediating effects of BMI,WC,WHR and WHt R on the relationship between age at menopause and SBP accounted for 33.22%(15.20%-105.20%),34.85%(16.32%-110.48%),22.62%(8.16%-77.68%)and 32.04%(14.05%-100.84%)of the total effects,respectively.The mediating effects of BMI,WC,WHR and WHt R on the relationship between age at menopause and DBP accounted for 26.81%(13.61%-52.65%),25.63%(13.14%-50.56%),13.93%(5.19%-29.15%)and 21.71%(10.40%-42.75%)of the total effects,respectively.Conclusions:Early and late age at menopause increases the risk of MS and obesity.With the increase of MS group score,the risk of MS group score with late age at menopause increased.Late age at menopause increases the risk of MS mainly within 10 years after menopause.Late age at menopause increases the risk of hypertension.Obesity indicators have a mediating effect on the relationship between age at menopause and blood pressure.Strengthening the management of obesity after menopause is conducive to the control of not only obesity,but also hypertension.